Provider Demographics
NPI:1538502166
Name:MIMS, RALSTON JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:RALSTON
Middle Name:JOSEPH
Last Name:MIMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 ASHLAND WOODS LN
Mailing Address - Street 2:APT. A2
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8348 TRAFORD LN
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1663
Practice Address - Country:US
Practice Address - Phone:703-569-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist